The effect of cardiac venting technique for aortic valve replacement surgery on the incidence of postoperative atrial fibrillation

Atrial arrhythmias are the most common complication after open heart surgery. Only a few studies have presented the incidence and risk factors of postoperative atrial fibrillation (POAF) after isolated aortic valve replacement surgery (AVR). Furthermore, the scarring resulting from the side of the vent implantation may create areas of slow conduction that allow a substrate for re-entry. The aim of the study is to compare the effect of the venting technique used during AVR - through the pulmonary artery (PA) or the pulmonary vein (PV) - on POAF incidence. Patients with no history of permanent atrial fibrillation (AF) and no pacemaker implanted (n = 497) who underwent isolated AVR were included in this retrospective study. Using a venting technique through the PV in comparison to a venting technique through the PA is associated with a significant prolongation of cardiopulmonary bypass time by 10.6 minutes (p < 0.0001, 95% CI 7.76-13.35), aortic clamping time by 7.7 minutes (p < 0.0001, 95% CI 5.34-10.16), intensive care unit time by 1 day (p = 0.0025, 95% CI 0.34-1.56) and hospitalization time by 1.4 days (p = 0.003, 95% CI 0.34-2.23). The patient group with the PV venting technique showed a 32% increase in POAF when compared with the incidence observed in the PA venting group (34% - PA, 45% - PV, p = 0.03). Univariable regression analysis also showed the venting technique through the PV to be a risk factor for POAF (p = 0.04, OR 1.50, 95% CI 1.02-2.22).